Implantable retention system and method

ABSTRACT

An implantable anchor for anchoring a lead or catheter relative to biological tissue, implantable system including such an anchor and a lead or catheter, and a method of use of such anchor. The anchor comprises a body having a channel adapted to receive a catheter or lead, and a cover mounted on the body for pivoting motion along a lateral axis, that is an axis that extends generally in the lateral direction perpendicular to the catheter or lead, between an open position in which the anchor is adapted to allow a lead or catheter to be placed in or moved along the channel, and a locked position in which the anchor is adapted to retain a lead or catheter within the channel.

RELATED APPLICATION

This application claims priority to U.S. Provisional Application No.60/642,248, filed Jan. 7, 2005. U.S. Provisional Application No.60/642,248 is hereby incorporated herein by reference in its entirety.

FIELD

This application generally relates to implantable lead or catheterretention systems, and more particularly to retention systems thatanchor medical electrical leads or drug delivery catheters to biologicaltissue.

BACKGROUND

Medical electrical leads or drug delivery catheters (hereafter referredto as therapy devices) are placed in the contact with biological tissueto delivery a therapy to the patient. These therapy devices are part ofa system that may include signal or pulse generators (IPGs) or drugdelivery pumps or combinations of such. The stimulators or pumps in thesystem may be external to, or implanted in, the patient.

Medical electrical leads may be used, for example, to deliveryelectrical energy to various biological tissues such as the heart,brain, or peripheral nervous system, etc. For example, implantableleads, such as the Medtronic Model 3487A lead, have been used forstimulating the dorsal columns of the spinal cord, or implantable leads,such as the Medtronic Model 3587A, have been used for peripheral nervestimulation.

Medical drug delivery catheters, for example, may be used to deliverytherapeutic agents to the intrathecal space of the spinal canal, or tothe blood vasculature, or brain ventricles, etc. Catheters such as theMedtronic Model 8703 may be used for these types of applications.

Various lead or catheter anchors or retention systems are described inU.S. Pat. Nos. 5,683,446; 5,746,722; 5,824,032; 5,957,968 and 6,901,287;US published patent application Publication No. 2003/0220678; EuropeanPatent Publication No. 1,048,320; and PCT International Publication No.WO 03/099375.

BRIEF SUMMARY OF EXEMPLARY EMBODIMENTS

Examplary embodiments of the retention system serve to prevent therapydevice migration after implantation of leads or catheters in thepatient. Implantable neurostimulation or drug delivery systems areexemplified in this application for purposes of illustration, but oneskilled in the art would realize that the concepts presented would beapplicable to other medical devices such as heart pacemaker anddefibrillators as well as other drug delivery methods.

In a first exemplary embodiment, an implantable anchor is provided foranchoring a lead or catheter relative to biological tissue. The anchorof the first exemplary embodiment generally comprises a body having achannel adapted to receive a catheter or lead, and a cover. The channeldefines a longitudinal axis, and the cover is mounted on the body forpivoting motion, along a lateral axis generally perpendicular to thelongitudinal axis, between: an open position in which the anchor isadapted to allow a lead or catheter to be placed in or moved along thechannel, and a locked position in which the anchor is adapted to retaina lead or catheter within the channel.

In a second exemplary embodiment, a method is provided for anchoring anelongate medical device to biological tissue. The method of the secondexemplary embodiment generally comprises providing an anchor having abody and a cover in which the cover is in an open position; placing theelongate medical device in a channel defined in the body of the anchor;pivoting the cover relative to the body, along an axis that isperpendicular to the longitudinal axis of the elongate medical device,to a locked position in which the cover presses against the elongatemedical device; and suturing the anchor to biological tissue.

Exemplary embodiments of the retention systems prevent therapy devicemigration after implantation. Exemplary hinged cover may provide forzero, or near zero, insertion force when in the open position andsufficient device retention force when in the closed position. Thehinged cover may also contain a locking mechanism to provide positiveengagement with the body portion of the retention system.

Exemplary embodiments of the invention may provide: 1) zero or near-zeroinsertion force, 2) sufficient retention force, 3) gripping features onthe internal surfaces of the hinged portion and the body portion of theretention device, 4) secure hinged portion closure features, 5) soft endcaps to provide strain relief to prevent therapy device kinking and 6)positive closure features to engage hinged portion with body portion.

The exemplary lateral axis (i.e. an axis extending in the lateraldirection, and not merely an axis displaced laterally from thelongitudinal axis) may help provide a more generally uniform retentionforce along the circumference of the lead or catheter.

As used herein, the term, “exemplary” is used in the sense of forexample or for purposes of illustration, and not in a limiting sense.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 shows a general environmental view for an exemplary embodiment ofa neurostimulation or drug delivery system used to provide therapy tothe spinal cord.

FIG. 2 shows the exemplary neurostimulation system of FIG. 1.

FIG. 3 shows the exemplary lead of FIGS. 1 and 2.

FIG. 4 shows an exemplary drug delivery environment.

FIG. 5 shows an exemplary drug delivery system.

FIG. 6 shows the exemplary catheter of FIGS. 4 and 5.

FIG. 7 shows the perspective view of a first exemplary embodiment of theanchor.

FIG. 8 shows an exploded view of the anchor of FIG. 7.

FIG. 9 shows an alternate exploded view of the anchor of FIGS. 7 and 8.

FIG. 10 shows a side view of the anchor of FIGS. 7-9 with the hingedportion or cover in the open position.

FIG. 11 shows a side view of the anchor of FIGS. 7-10 with the hingedportion or cover in the closed or locked position.

FIG. 12 shows a perspective view of a second exemplary embodiment of theanchor.

FIG. 13 shows an exploded view of the exemplary anchor of FIG. 12.

FIG. 14 shows an alternate exploded view of the exemplary embodiment ofFIGS. 12 and 13.

FIG. 15 shows a side view of the exemplary anchor of FIGS. 12-14 withthe hinged portion or cover in the open position.

FIG. 16 shows a side view of the anchor of FIGS. 12-15 with the hingedportion or cover closed in the locked position, and lead engaged.

FIG. 17 shows an exploded view of third exemplary embodiment of theanchor with a swivel portion.

DETAILED DESCRIPTION OF THE EXEMPLARY EMBODIMENTS

FIG. 1 shows a general environmental view 10 for an exemplaryimplantable neurostimulation system. Neurostimulation systems may beused to treat conditions such as pain, movement disorders, pelvic floordisorders, gastroparesis, and a wide variety of other medicalconditions. As illustrated in FIGS. 1 and 2, the neurostimulation system20 may include a neurostimulator 22, one or more stimulation leadextension(s) 30, and one or more stimulation lead(s) 40. Theneurostimulator 22 is typically implanted subcutaneously in thepatient's body 28 at a location selected by the clinician. Thestimulation lead 40 is typically fixed in place near the locationselected by the clinician using a device such as an adjustable anchor.Examples include placing the lead in the epidural space near the spinalcord, in or along the brain, or in muscle or subcutaneous tissue.

The exemplary implantable neurostimulator 22 has a housing, a powersupply in the housing 24, and stimulation electronics in the housing inelectrical communication with the battery and in electricalcommunication with a connector block 26, which may also be known as aterminal block.

The exemplary stimulation lead 40 shown in FIG. 3, has a proximal endportion 45, a distal end portion 41 and a lead body 43 extending betweenthe proximal end portion 45 and distal end portion 41. The proximal endportion 45 has at least one electrical connector 46 (also known aselectrical terminals or contacts), with various standard pluralities,such as four or eight electrical contacts, being typical. The distal endportion 41 has at least one stimulation electrode 42, with variousstandard pluralities, such as four or eight electrodes, being typical.

There is at least one lead conductor 50 contained in the lead body 43that is electrically connecting the electrical connector 46 to thestimulation electrode 42. Typically, at least one conductor may be usedto establish electrical communication between a single electricalconnector/electrode pair, although alternative examples includemultiplexing or bus features within the lead to allow use of fewerconductors along the length of the lead than the number of electrodes.As used herein, “conductive means” or “means for electricalcommunication between electrodes and electrical connectors include theforegoing examples or any alternative structure to allow selection orelectrical activation of one or more electrode.

FIG. 4 shows a general environmental view 10 for an exemplaryimplantable drug delivery system embodiment. Drug delivery systems maybe used to treat conditions such as pain, movement disorders, diabetesand a wide variety of other medical conditions. As illustrated in FIGS.4 and 5, the drug delivery system 12 may include a drug delivery pump13, a proximal catheter portion and a distal catheter portion 14. Thedrug pump 13 is typically implanted subcutaneously in the patient's body28 at a location selected by the clinician. The distal catheter portion14 is typically fixed in place near the location selected by theclinician using a device such as an adjustable anchor.

The exemplary implantable drug delivery pump 13 has a housing, a powersupply in the housing 17, pumping mechanism and pump electronics in thehousing. The pumping mechanism is in direct communication with thetherapy delivery element through the connector 24 also part of thehousing 17.

The therapy delivery element in a drug delivery system may include adistal catheter 14 and an optional proximal catheter 16. Both proximalcatheter 16 and distal catheter 14 have a lumen therethough.

FIG. 6 shows an exemplary distal catheter 14. The catheter is generallycylindrical in shape with lumen 18 therethrough. More that one lumen maybe present in distal catheter 14. In addition, elements may be includedin proximal catheter 14 to provide hoop strength to the device toprevent kinking or crushing.

A retention system using mechanical gripping may be used to preventmigration of the therapy delivery element after a therapy site has beenchosen. Preferred exemplary embodiments of this invention use a hingedmechanism that provide compressive forces on the therapy deliveryelement when closed. An added benefit of the exemplary embodiments is azero insertion force property. This property allows the retention systemto be utilized with therapy deliver devices that may or may not haveadequate structure to prevent buckling of therapy device while beinginserted into the retention system. The system may also employ softflexible ends to mitigate potential lead issues related to bending ofthe lead as it enters the fascia.

As illustrated in FIGS. 7-11, a first exemplary retention system oranchor 100 includes a body 110, a hinged portion or cover 120 and aproximal and distal soft portion 130. The body 110 has a lumen orchannel (or preferably a combination of two lumens 108 and a channel109) defining a longitudinal axis or direction, with the lumen and/orchannels being adapted to receive a lead or catheter. The channel 109,and optionally the lumens 108, form(s) an exemplary embodiment of ameans for receiving an elongate medical device (e.g., catheter or lead),with such receiving means defining a longitudinal axis.

The cover 102 is mounted on the body 110 for pivoting motion, along alateral axis generally perpendicular to the longitudinal axis, between:an open position (e.g., FIG. 10) in which the anchor 100 is adapted toallow a lead or catheter to be placed in or moved along the channel 109or lumens 108, and a locked position (e.g., FIG. 11) in which the anchor110 is adapted to retain a lead or catheter within the channel 109 orlumens 108. For example, body 110 may have protrusions 111 that define afixed pivot portion of a hinge with a hinge axis that is generallyperpendicular (i.e. the lateral direction or lateral axis) to thelongitudinal axis of the body 110. Hinged portion 120 has tab features115 with holes 117 therethrough, which define the rotational portion ofthe hinge. The protrusions 111 on the body and tab features 115 withthrough holes constitute an exemplary embodiment of an axis means forproviding an axis for pivotable motion that is generally perpendicularto the longitudinal axis defined by the receiving means (e.g., channel109).

The hinged portion may also optionally include locking feature 124 thatprovide an interference interaction with the body portion 110. Thisinterference may be in the form of a frictional fit orsnap-fit/snap-lock, e.g., the body 110 may include an indentation toreceive locking feature 124 providing secure closure of the hingedportion. Such features form a snap lock mechanism formed by the cover120 and body 110 to retain the cover 120 in the locked position. Thesnap lock mechanism forms an exemplary embodiment of a means, orsnap-lock means, for retaining the cover 120 in the locked position.

The body portion 110 also includes at least one suture-receiving groove112 (two are shown in FIG. 7). The suture-receiving annular groove 112may be formed along the cover 120 and the body 110 such that the cover120 is adapted to be held in its locked position by tying a suture inthe suture-receiving annular groove 112.

The body 110 and cover 120 may be formed of substantially rigid resinmaterial. For example, the body 110 and hinged portion 120 may be formedof any suitable material, such as for example polycarbonate orpolysulfone.

Soft, flexible ends 130 may be provided on the ends of the end caps 114.FIGS. 7 and 8 illustrate two such soft, flexible ends 130, one on eachend. Such soft flexible ends may take the form, for example, of twotubular members 130 mounted on the body 110 and extending longitudinallyfrom the body 110 in opposite directions. The flexible end 130 may beprovided with suture-receiving grooves 113 (one shown in FIGS. 7 and 8for each end). Soft end members 130 may be formed of any suitablematerial, such as elastomeric materials (e.g., silicone rubber orpolyurethane).

The lumens 108 of the body 110 preferably are formed at opposite ends ofthe channel 109 and in alignment with the channel 109. The cover 120preferably forms a channel 121 that aligns with the channel 109 of thebody 110 to substantially to form a lumen in alignment with the lumens108. Hinged portion 120 and body 110 have surface features 116, whichmay include grooves or threads, along the channel 109. Such surfacefeatures 116 may be formed to increase the retaining force on the leador catheter.

FIG. 10 shows a side view of the retention system 100 with the hingedportion 110 open. The retention system 100 is ready to receive a therapydelivery element (e.g., elongate medical device), such as a medicalelectrical lead of the types that may be used for electrical stimulationof tissue or monitoring/sensing, or a drug delivery catheter.

After the therapy delivery element is inserted through the retentionsystem and the retention system is positioned to the practitionersliking, the hinged portion 120 is closed. Closure of the hinged portion120 causes surface feature 116 to come into interference contact withthe therapy delivery element. This interaction, in the form ofcompressive force, provides the retention force preventing therapydelivery element migration. When the hinged portion 120 is closed,optional locking feature 124 will interact with body 110. Thisinteraction will provide an initial secure closure of the hinged portionand insure adequate compressive forces are applied. Once the hingedportion 120 is closed, sutures may be applied circumferentially aboutthe retention system to prevent inadvertent opening of the hingedportion. In addition, the sutures are secured to the tissue fascia inthe immediate vicinity of the retention system to prevent movement ofthe retention system.

FIG. 11 shows the lead retention system engaging the therapy deliveryelement 40 (sutures not shown), with the cover 120 in the lockedposition.

FIGS. 12-16 illustrate a second exemplary embodiment of the retentionsystem, now designated by the reference characters 200. Retention system200 performs a similar function as retention system 100, and contains anadditional element in the form of wings or flanges 212 and wings 222.Wings 212 are rigidly fixed to body 210 and provide a mating surface forwings 222 rigidly fixed to hinged portion or cover 220. When hingedportion 220 is closed to actuate therapy delivery element retention,wings 222 contact wings 212.

Tabs 226 on wings 222 alternately engage wings 212 to provide initialsecure closure of hinged portion 220. The tabs 226 may be in the form ofdeflectable locking arms 226 on the cover 220, with the deflectablelocking arms 226 being adapted to snap over the flange 212 as the cover220 is moved to its locked position (e.g., FIG. 16) to retain the coverin its closed position. The tabs 226 form a second exemplary snap lockmechanism formed by the cover 220 and body 210 to retain the cover 220in the locked position. The foregoing exemplary snap lock mechanismforms a second embodiment of a means, or snap-lock means, for retainingthe cover in the locked position.

Hinged portion 220 and body 210 contain holes therethrough. Holes 224align with holes 214 when the hinged portion 220 is closed (i.e. in thelocked position). Sutures may be placed through the now aligned holes214 and 224 to provide secure closure of hinged portion 220 insuringadequate compressive force is placed on the therapy delivery element andto prevent inadvertent opening of the hinged portion. In addition,suture may be placed circumferentially around the retention system toprovide additional secure closure of the hinged portion.

FIG. 17 illustrates a third exemplary embodiment similar in manyrespects to the first embodiment illustrated in FIGS. 7-11. In thisembodiment, the anchor 300 includes a cover 320 that includes a singleflange 322 with a single rotation-axis defining through hole 317, whichreceives a single protrusion 311 on the body 310 of the anchor 300. Thethrough hole 317 and protrusion 311 constitutes an alternative exemplaryembodiment of an axis means for providing an axis for pivotable motionthat is generally perpendicular to the longitudinal axis defined by thereceiving means. In an optional version of this exemplary embodiment,the through hole 317 and protrusion 311 may be configured to allowpivoting and swiveling motion to allow the benefits of the lateralrotational axis to be combined with the benefits of a swivel.

The anchor 100, 200 or 300 may be used in exemplary methods of anchoringan elongate medical device (e.g., catheter or lead) to biologicaltissue. With the cover in the open position, the elongate medical devicemay be placed in the channel 109 defined in the body of the anchor. Thecover 120, 220, 320 may then be pivoted relative to the body 110, 210,310, along the lateral axis, to a locked position (e.g., FIGS. 11 and17) in which the cover 120, 220, 320 presses against the elongatemedical device.

The cover may optionally be locked in its locked position with a snaplock mechanism formed by the cover and body, such as by use of features124 or 226. For example, the cover may be locked in its locked positionby deflecting locking arms 226 on the cover 220 over a flange 212 on thebody 210 such that the locking arms 226 being snap over the flange 212as the cover 220 is moved to its locked position

The anchor may then be sutured to biological tissue using any or all ofthe suture-related features described with respect to the variousexemplary embodiments. For example, a suture-receiving through hole 224of the cover 220 may be moved into alignment with a suture-receivingthrough hole 214 of the body 210 when the cover 220 is moved to itslocked position (e.g., FIG. 17) as the cover 220 is pivoted relative tothe body 210 to the locked position. Another example includes tying atleast one suture along a suture-receiving annular groove 112 formed bythe cover 120 and the body 110 such that the cover 120 is held in itslocked position by the suture. It will be appreciated that the twoforegoing examples could optionally be combined in a single device, suchas by using suture receiving grooves 213 and 215 on the cover 220 andbody 210, respectively. Sutures may also be placed along the suturereceiving grooves 113 of the soft end members 130.

Thus, embodiments of the implantable electrical lead retention system,implantable anchor, implantable system and method are disclosed. Thedisclosed embodiments are presented for purposes of illustration and notlimitation.

1. An implantable anchor for anchoring a lead or catheter relative tobiological tissue, the anchor comprising: a body having a channeladapted to receive a catheter or lead, the channel defining alongitudinal axis, the channel maintaining the longitudinal axis from anopening on one end of the body to an opening on another end of the body;a cover mounted on the body such that the cover pivots on a lateral axisgenerally perpendicular to the longitudinal axis and between: an openposition in which the anchor is adapted to allow a lead or catheter tobe placed in or moved along the channel, and a locked position in whichthe anchor is adapted to retain a lead or catheter within the channel.2. The implantable anchor of claim 1 further comprising a snap lockmechanism formed by the cover and body to retain the cover in the lockedposition.
 3. The implantable anchor of claim 2 wherein the snap lockmechanism includes: a flange on the body; and deflectable locking armson the cover, the deflectable locking arms being adapted to snap overthe flange as the cover is moved to its locked position to retain thecover in its closed position.
 4. The implantable anchor of claim 3wherein at least one suture-receiving through hole is formed in each ofthe cover and the body such that the suture-receiving through hole ofthe cover is in alignment with the suture-receiving through hole of thebody when the cover is in its locked position.
 5. The implantable anchorof claim 1 wherein at least one suture-receiving annular groove isformed along the cover and the body such that the cover is adapted to beheld in its locked position by tying a suture in the suture-receivingannular groove.
 6. The implantable anchor of claim 1 wherein the body isformed of substantially rigid resin material, the implantable anchorfurther including two tubular members mounted on the body and extendinglongitudinally from the body in opposite directions, the tubular membersbeing substantially elastomeric.
 7. An implantable system comprising: anelongate medical device selected from the group consisting of animplantable medical lead for electrically stimulating or sensing tissueand an implantable catheter for delivering therapeutic substances, suchas drugs or biologics; and an implantable anchor for anchoring theelongate medical device relative to the biological tissue, the anchorcomprising: a body having a channel for receiving the elongate medicaldevice, the channel defining a longitudinal axis and the body providingprotrusions defining a lateral axis; and a cover mounted on the bodysuch that the cover pivots on the lateral axis about the protrusions andgenerally perpendicular to the longitudinal axis and between: an openposition in which the anchor allows the elongate medical device to beplaced in or moved along the channel, and a locked position in which theanchor is retains the elongate medical device within the channel.
 8. Theimplantable system of claim 7 further comprising a snap lock mechanismformed by the cover and body to retain the cover in the locked position.9. The implantable system of claim 8 wherein the snap lock mechanismincludes: a flange on the body; and deflectable locking arms on thecover, the deflectable locking arms being adapted to snap over theflange as the cover is moved to its locked position to retain the coverin its closed position.
 10. The implantable system of claim 9 wherein atleast one suture-receiving through hole is formed in each of the coverand the body such that the suture-receiving through hole of the cover isin alignment with the suture-receiving through hole of the body when thecover is in its locked position.
 11. The implantable system of claim 7wherein at least one suture-receiving annular groove is formed along thecover and the body such that the cover is adapted to be held in itslocked position by tying a suture in the suture-receiving annulargroove.
 12. The implantable system of claim 7 wherein the body is formedof substantially rigid resin material, the implantable anchor furtherincluding two tubular members mounted on the body and extendinglongitudinally from the body in opposite directions, the tubular membersbeing substantially elastomeric.
 13. The implantable system of claim 7wherein the elongate medical device is an implantable medical lead forelectrically stimulating or sensing tissue.
 14. The implantable systemof claim 13 further comprising an implantable pulse or signal generatorelectrically coupled with the implantable medical lead.
 15. Animplantable anchor for anchoring an elongate medical device relative tobiological tissue, the anchor comprising: a body having receiving meansfor receiving the elongate medical device, the receiving means defininga longitudinal axis and including surface features; axis means forproviding an axis for pivotable motion that is generally perpendicularto the longitudinal axis defined by the receiving means; and a covermounted on the body via the axis means such that the cover pivots on alateral axis and between: an open position in which the anchor isadapted to allow the elongate medical device to be placed in or movedalong the receiving means, and a locked position in which the anchor isadapted to retain the elongate medical device within the receiving meansby creating contact of the surface features to the elongate medicaldevice.
 16. An implantable anchor for anchoring a lead or catheterrelative to biological tissue, the anchor comprising: a body having achannel adapted to receive a catheter or lead, the channel defining alongitudinal axis, the body further having a lumen on each end of thechannel each lumen sharing the longitudinal axis of the channel; and acover mounted on the body such that the cover pivots on a lateral axisgenerally perpendicular to the longitudinal axis and between: an openposition in which the anchor is adapted to allow a lead or catheter tobe placed in or moved along the channel and the lumen, and a lockedposition in which the anchor is adapted to retain a lead or catheterwithin the channel and the lumen.